CalAIM Lead Care Specialist

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New Beginnings is seeking a qualified and experienced CalAIM Lead Care Specialist to provide comprehensive support for the Enhanced Care Management (ECM) and Community Supports (CS) programs under our CalAIM initiative. The CalAIM Lead Care Specialist will provide support in conjunction with the Authorization Specialist and Billing Specialist to ensure that all ECM and CS activities are effectively managed, including utilization management, member assignment, and reporting.

This role requires a deep understanding of Medi-Cal and CalAIM processes, and the ability to optimize service delivery while ensuring compliance with all relevant regulations and standards.

• Program Oversight: Provide oversight for all ECM activities, including utilization management, member assignment, and reporting. Ensure that all program deliverables are met and that ECM and Community Supports services are delivered effectively and efficiently.
• Regulatory Compliance: Stay current with state and federal regulations related to CalAIM, Medi-Cal, and ECM/CS. Ensure that all activities and documentation meet regulatory requirements and that the program remains in full compliance.
• Care Management: Track and ensure the timely completion of ECM assessments and care plans. Oversee the documentation of Community Supports services, ensuring that all records are accurate and complete.
• Provider Oversight: Provide trainings and, with other members of the CalAIM team, be the go-to support for general staff that need help understanding CalAIM forms, the billing process, and following care plans. Provide oversight of ECM and Community Supports service provision by program staff in conjunction with Program Directors, ensuring that core services are delivered as required. Work closely with providers and Program Directors to optimize service delivery and address any issues or concerns that arise.
• Process Optimization: Optimize internal and external CalAIM processes, making recommendations for improvements to enhance service delivery and program efficiency. Ensure processes are streamlined for Caseworkers while still aligning with CalAIM guidelines.
• Documentation and Reporting: Review case notes for all claims made and related documentation in the Health Management Information System (HMIS). Assist in tracking authorizations and reauthorizations and assist with claims reviews as necessary to ensure accurate and timely billing.
• Quality Improvement: Participate in internal and external meetings as necessary. Provide suggestions for quality improvement initiatives to enhance the effectiveness of ECM and Community Supports programs.
• Additional Duties: Perform other duties as assigned by the Program Director, Homeless Services Director and Executive Director to support the successful implementation and operation of the CalAIM initiative.

• Education:
  • Bachelor’s degree in social work, psychology, counseling, nursing, public health, business or a related field.
• Experience:
  • o Minimum of 1-2 years of experience working with Medi-Cal/Cen Cal systems management.
  • Experience in managing care coordination tasks.
  • Proven track record in implementing CalAIM or similar healthcare programs preferred.
  • Familiarity with utilization management, provider oversight, and billing processes in a healthcare setting.
• Skills and
  
  Competencies:
  
  
  • Strong Team Player with the ability to work cohesively in a team environment.
  • In-depth knowledge of Medi-Cal, CalAIM, and the needs of the Medi-Cal member population.
  • Excellent organizational and time-management skills.
  • Ability to analyze complex data, review documentation, and track program performance.
  • Strong communication skills, both written and verbal, with the ability to work collaboratively with a variety of stakeholders.
  • Proficiency in HMIS and other care management software preferred but not required.
  • Familiar with client intake and assessments
  • Ability to work unsupervised, in the field for part of shift with a commitment to issues related to ending homelessness through employment
  • Ability to set priorities, meet deadlines and follow through
  • Excellent written and oral communication skills
  • Strong…